10 things to know about health-insurance and ACA trends in Michigan

This article appeared in MLive. Read more here.

Many voters are listing health care as one of their top issues in the 2020 presidential election.

And much of that debate is centering around the Affordable Care Act, which was fully implemented in 2014.

Many conservatives would like to scrap the law — and, in fact, there’s a pending federal court case that could do just that. Meanwhile, many progressives would like to go farther and adopt a version of Medicare for All.

Rather than dive into the pros and cons of those positions, this post offers facts and figures on how Obamacare has impacted Michigan residents, based on data from the U.S. Census and other sources.

1. Number of uninsured has dropped by more than half.

The Census estimates that about 5.4% Michigan residents — or 535,000 people– lacked health insurance in 2018. That compares to 12.4%, or 1.2 million, in 2010 and 10.9%, or 1,071521, in 2013, the year before the ACA was fully implemented.

Below is a map that shows the counties with the biggest increases in the percent of residents with health insurance, based on Census averages for 2009-13 compared to the averages for 2014-18. You can put your cursor over a county to see the underlying data.

The five counties with the biggest increases in health-care coverage since 2013: Gogebic, Lake, Mecosta, Wayne and Benzie.

2. Almost all the Michigan residents who gained insurance through the ACA are working-age adults.

Michigan residents age 19 to 64 have been most likely to lack insurance, and they’ve made the biggest gains under Obamacare.

That’s because senior citizens age 65 and older are covered by Medicare, while Michigan children not covered by their parents have long been eligible for Medicaid or MiChild.

Here’s a look at the percentage covered by health insurance before and after the ACA.

There are three ways that Obamacare has improved access to insurance for working-age adults: It mandates that family policies cover children to age 26; created the Healthy Michigan plan to cover the uninsured adults with an income under 138% of the poverty line, and subsidizes insurance for those between 138% and 400% of the poverty line.

3. Uninsured rates among young adults have dropped by two-thirds.

Among Michigan young adults, the number who are uninsured has plummeted, largely due to the ACA provision that allows them to stay on their parents’ health insurance up to age 26.

In 2009, before that ACA provision kicked in, 30% of Michiganders age 18 to 24 lacked health insurance. In 2018, 9% of those age 19 to 25 were uninsured.

4. The percent of Michigan residents with public insurance has increased from 34% to 39%.

The Healthy Michigan program has significantly increased the number of working-age Michigan residents on Medicaid. But Michigan’s aging population also has increased the number of residents getting Medicare.

Broken down by age group:

• 39% of those under age 18 in 2018 were covered by Medicaid, MiChild and/or Medicare. That compares to 40% in 2013.
• 23% of those age 19 to 64 had public insurance in 2018 compared to 17% in 2013.
• 98% of Michigan residents age 65 and older are on Medicare, a percentage that is unchanged between 2013 and 2018.

In all, the number of Michigan residents with public insurance grew by about 488,000 people between 2013 and 2018. About 57% were age 19 to 64, while the other 43% were age 65 and older.

Below is a map that shows the counties with the biggest increases in the percent of residents with public health insurance, based on Census averages for 2009-13 compared to the averages for 2014-18. You can put your cursor over a county to see the underlying data.

The top five counties for public insurance coverage: Alcona (61%), Lake (61%), Roscommon (59%), Montmorency (59%) and Iosco (57%).

5. The percentage under age 65 with private insurance has increased from 68% to 71%.

In 2013, about 68% of Michigan residents under age 65 had private insurance coverage. That compares to 71% in 2018.

The vast majority with private coverage obtained that insurance through an employer. About 5% in both 2013 and 2018 purchased plans on their own.

In 2019, about 245,000 Michigan individuals purchased so-called Obamacare plans on the federal marketplace, and about 87% qualified for subsidies to help pay for premiums.

Below is a map that shows the counties with the biggest increases and decreases in the percent of residents with private health insurance, based on Census averages for 2009-13 compared to the averages for 2014-18. You can put your cursor over a county to see the underlying data. (Note: This data includes senior citizens with private insurance to supplement Medicare.)

The five counties with the highest rates of residents covered by private insurance: Livingston(85%), Washtenaw (84%), Clinton (83%), Ottawa (82%) and Oakland (81%).

The five counties with the lower rates of private insurance: Lake (54%), Clare (55%), Oscoda (57%), Oceana (60%) and Wayne (60%).

6. By race, African-Americans and Hispanics have seen the biggest drops in percentage of uninsured.

Since 2013, all racial groups have seen significant drops in the percentage of uninsured residents, but it’s particularly significant for minorities.

7. Number of uninsured workers has dropped significantly.

In 2013, Michigan had almost 300,000 full-time workers who lack health-care insurance and another 421,000 part-time workers who were uninsured. That was 10.5% of all full-time workers and 20% of part-time employees.

In 2018, 6% of full-time workers and 11% of part-time workers were uninsured.

8. Those with household incomes under $50,000 have seen the most dramatic drops in number of uninsured.

Every income group has seen the number of uninsured drop, but low- and moderate-income households have seen the biggest change.

9. Good and bad news on health-care costs.

The good news: The rate of increases for health insurance has slowed some. But the increases are still outpacing inflation and increases in wages — which is why health care is such a hot issue.

Nationally, the average cost of a family health-care insurance plan was $20,576 in 2019, according to the Kaiser Family Foundation’s annual survey of employer-sponsored plans.

That’s up 22% since 2014. By comparison, the average grew 26% between 2009 and 2014, and 34% between 2004 and 2009, the Kaiser data shows.

In 2019, employees on average contributed 18% of the premium for single coverage and 30% of the premium for family coverage, the Kaiser study shows. The average monthly worker contributions were $103 for single coverage ($1,242 annually) and $501 for family coverage ($6,015 annually).

The average deductible was $1,655 for an individual plan and $4,770 for a family plan. The latter takes into account deductibles for individual family members.

10. Who still lacks insurance?

Of the half-million Michigan residents who were uninsured in 2018:

• 15% were children under age 18, while 85% were between the ages of 19 and 64. Less than 1% were age 65 or older.
• 68% of the uninsured adults were employed in 2018. Among those who worked, about half had full-time jobs and half had part-time jobs.
• Among the industries with a disproportionate number of uninsured workers: Agriculture, construction, retail and service industries.
• Median earnings of adults without insurance was $21,618 in 2018 and their median household income was $36,589.